Dementia friendly dentistry for the periodontal patient. Part 2: ethical treatment planning and management


This is the second of two articles, which provide a guide to aid the clinical management of people living with dementia who present with periodontitis in dental practice. Guidance is provided to encourage optimal treatment planning and periodontal care for patients with dementia. Best practice in relation to UK statutory legislation, which governs the rights of those with impaired capacity, is also covered. Although the articles centre on periodontal care, much of the content is equally applicable to the wider general dental care for the dementia patient.

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  1. 1.

    Cicciu M, Matacena G, Signorino F et al. Relationship between oral health and its impact on the quality life of Alzheimer's disease patients: a supportive care trial. Int J Clin Exp Med 2013; 6: 766-772.

  2. 2.

    Bramanti E, Bramanti A, Matacena G et al. Clinical evaluation of the oral health status in vascular-type dementia patients. A case-control study. Minerva Stomatol 2015; 64: 167-175.

  3. 3.

    Warren J J, Chalmers J M, Levy S M et al. Oral health of persons with and without dementia attending a geriatric clinic. Spec Care Dentist 1997; 17: 47-53.

  4. 4.

    Avlund K, Holm-Paedersen P, Morse D E et al. Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontol 2004; 21: 17-26.

  5. 5.

    Henry R G, Wekstein D R. Providing dental care for patients diagnosed with Alzheimer's disease. Dent Clin North Am 1997; 41: 915-943.

  6. 6.

    Cerajewska T L, Davies M, West N X. Periodontitis: a potential risk factor for Alzheimer's disease. Br Dent J 2015; 218: 29-34.

  7. 7.

    Cerajewska T L, West N X. Could periodontitis play a role in the pathogenesis of Alzheimer's disease. Perio Insight - Eur Fed Periodontol 2019; 9: 1-4.

  8. 8.

    Teixeira F B, Saito M T, Matheus F C et al. Periodontitis and Alzheimer's Disease: A Possible Comorbidity between Oral Chronic Inflammatory Condition and Neuroinflammation. Front Aging Neurosci 2017; 9: 327.

  9. 9.

    Harding A, Robinson S, Crean S et al. Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer's Disease? J Alzheimers Dis 2017; 58: 337-348.

  10. 10.

    Ide M, Harris M, Stevens A et al. Periodontitis and Cognitive Decline in Alzheimer's Disease. PLoS One 2016; 11: e0151081.

  11. 11.

    Prince M, Ali G C, Guerchet M et al. Recent global trends in the prevalence and incidence of dementia, and survival with dementia. Alz Res Ther 2016; 8: 23.

  12. 12.

    Delwel S, Binnekade T T, Perez R et al. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues. Clin Oral Investig 2018; 22: 93-108.

  13. 13.

    McGowan T, McGowan K, Ivanovski S. A Novel Evidence-Based Periodontal Prognosis Model. J Evid Based Dent Pract 2017; 17: 350-360.

  14. 14.

    Kayser AF. Shortened dental arches and oral function. J Oral Rehab 1981; 8: 457-462.

  15. 15.

    Dougall A, Fiske J. Access to special care dentistry, part 9. Special care dentistry services for older people. Br Dent J 2008; 205: 421-434.

  16. 16.

    Reisberg B, Ferris SH, de Leon M J et al. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139: 1136-1139.

  17. 17.

    Niessen L C, Jones J A, Zocchi M et al. Dental care for the patient with Alzheimer's disease. J Am Dent Assoc 1985; 110: 207-209.

  18. 18.

    Baranov D, Bickler P E, Crosby G J et al. Consensus statement: First International Workshop on Anaesthetics and Alzheimer's disease. Anesth Analg 2009; 108: 1627-1630.

  19. 19.

    Jevtovic-Todorovic V. General Anaesthetics and Neurotoxicity: How Much Do We Know? Anaesthesiol Clin 2016; 34: 439-451.

  20. 20.

    Seitz D P, Shah P S, Herrmann N et al. Exposure to general anaesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis. BMC Geriatr 2011; 11: 83.

  21. 21.

    Wachtel H, Fickl S, Zuhr O et al. The double-sling suture: a modified technique for primary wound closure. Eur J Esthet Dent 2006; 1: 314-324.

  22. 22.

    Ship J A, Puckett S A. Longitudinal study on oral health in subjects with Alzheimer's disease. J Am Geriatr Soc 1994; 42: 57-63.

  23. 23.

    Jones J A, Lavallee N, Alman J et al. Caries incidence in patients with dementia. Gerodontol 1993; 10: 76-82.

  24. 24.

    Fjeld K G, Mowe M, Eide H et al. Effect of electric toothbrush on residents' oral hygiene: a randomized clinical trial in nursing homes. Eur J Oral Sci 2014; 122: 142-148.

  25. 25.

    Zenthofer A, Meyer-Kuhling I, Hufeland A L et al. Carers' education improves oral health of older people suffering from dementia - results of an intervention study. Clin Interv Aging 2016; 11: 1755-1762.

  26. 26.

    Blackhall A, Hawkes D, Hingley D et al. VERA framework: communicating with people who have dementia. Nurs Stand 2011; 26: 35-39.

  27. 27.

    Social Care Institute for Excellence. Behavioural challenges when supporting a patient with dementia. Available at (accessed April 2019).

  28. 28.

    Shim Y J, Choi J H, Ahn H J et al. Effect of sodium lauryl sulphate on recurrent aphthous stomatitis: a randomized controlled clinical trial. Oral Dis 2012; 18: 655-660.

  29. 29.

    Van Leeuwen M P, Slot D E, Van der Weijden G A. Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review. J Periodontol 2011; 82: 174-194.

  30. 30.

    Walls A W, Meurman J H. Approaches to caries prevention and therapy in the elderly. Adv Dent Res 2012; 24: 36-40.

  31. 31.

    Kai K, Hashimoto M, Amano K et al. Relationship between eating disturbance and dementia severity in patients with Alzheimer's disease. PLoS One 2015; 10: e0133666.

  32. 32.

    Fiske J, Frenkel H, Griffiths J et al. Guidelines for the development of local standards of oral health care for people with dementia. Gerodontology 2006; 23: S5-32.

  33. 33.

    Friedlander A H, Norman D C, Mahler M E et al. Alzheimer's disease: psychopathology, medical management and dental implications. J Am Dent Assoc 2006; 137: 1240-1251.

  34. 34.

    Lewis A, Wallace J, Deutsch A et al. Improving the oral health of frail and functionally dependent elderly. Aust Dent J 2015; 60: S95-105.

  35. 35.

    Tonetti M S, Chapple I L, Jepsen S et al. Primary and secondary prevention of periodontal and peri-implant diseases: Introduction to, and objectives of the 11th European Workshop on Periodontology consensus conference. J Clin Periodontol 2015; 42: S1-S4.

  36. 36.

    National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. 2004. Available at (accessed September 2018).

  37. 37.

    Scottish Dental Clinical effectiveness programme. Oral health assessment and review. 2011.Available at (accessed September 2018).

  38. 38.

    Hilton C, Simons B. Dental surgery attendance among patients with moderately advanced dementia attending a day unit: a survey of carers' views. Br Dent J 2003; 195: 39-40.

  39. 39.

    United Kingdom Government. Mental Capacity Act 2005. London: The stationary office. Available at (accessed September 2018).

  40. 40.

    Scottish Government. Adults with incapacity (Scotland) Act 2000. Available at (accessed September 2018).

  41. 41.

    Northern Irish Assembly. Mental capacity Act (Northern Ireland) 2016. Available at (accessed September 2018).

  42. 42.

    Dougall A, Fiske J. Access to special care dentistry, part 3. Consent and capacity. Br Dent J 2008; 205: 71-81.

  43. 43.

    General Medical Council. Consent: Patients and Doctors making decisions together. (accessed September 2018).

  44. 44.

    Dental Protection. 2015 Consent: Scotland. Available at (accesed September 2018).

  45. 45.

    Dental Protection. Consent: UK excluding Scotland. 2015.

  46. 46.

    General Dental Council. Standards for the dental team. 2018. Available at (accessed May 2019).

  47. 47.

    Cooper C, Selwood A, Blanchard M et al. Abuse of people with dementia by family carers: representative cross sectional survey. BMJ 2009; 338: b155. DOI: 10.1136/bmj.b155.

  48. 48.

    Department of Health. Care Act 2014.-2014. Available at (accessed September 2018).

  49. 49.

    Scottish Government. Adult Support and Protection (Scotland) Act 2007. Available at (accessed September 2018).

  50. 50.

    National Assembly for Wales. Social Services and Wellbeing (Wales) Act 2014. Available at (accessed September 2018).

  51. 51.

    Northern Ireland Adult Safeguarding Partnership. Adult safeguarding operational procedures: adults at risk of harm and adults in need of protection. 2016. Available at (accessed September 2018).

  52. 52.

    Older people's commissioner for Wales. Adult protection contacts in Wales. 2016. Accessible at (accessed September 2018).

  53. 53.

    Child Protection Company. Local safeguarding adults boards. 2018. (accessed 22 September 2018).

  54. 54.

    Public Health England. Commissioning better oral health for vulnrable older adults. 2018. Available at (accessed May 19).

  55. 55.

    British Medical Journal. Management of dementia in primary care. 2012. Available at (accessed September 2018).

  56. 56.

    Guy's and St. Thomas' NHS Foundation Trust. Barbara's Story.British Medical Journal. 2012. Management of dementia in primary care. Available at (accessed September 2018).

  57. 57.

    National Health Service England Cheshire and Merseyside Health and Care Partnership. Dementia Friendly Dentistry: advice and guidance for the primary dental care team. 2016. Available at (accessed March 2019).

  58. 58.

    Faculty of General Dental Practice. Dementia-friendly dentistry: good practice guidelines. 2017. London UK. Available at (accessed November 2018).

  59. 59.

    Handley M, Bunn F, Goodman C. Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review. BMJ Open 2017; 7: e015257: DOI: 10.1136/bmjopen-2016-015257.

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Correspondence to Tanya L. Cerajewska.

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Cerajewska, T., West, N. Dementia friendly dentistry for the periodontal patient. Part 2: ethical treatment planning and management. Br Dent J 227, 570–576 (2019).

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